The fourth meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus was convened last week. Outcomes and the Committee’s final report will be made available on www.polioeradication.org.

The fourth meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus is convening this week. Outcomes and the Committee’s final report will be made available on www.polioeradication.org.

Ministers of Health from around the world will convene next week at WHO’s Executive Board meeting, to set global public health policies. Among other topics, representatives are expected to review the current polio epidemiology and global preparedness plans for the phased removal of oral polio vaccines. A report has been prepared, to facilitate discussions, available here.

More than 6 months have passed since the most recent case of wild poliovirus in central Africa was detected in Cameroon on the 9 July 2014. This indicates that progress towards stopping the outbreak in this region is being made. However, outbreak response activities must continue and subnational surveillance systems strengthened to ensure the rapid detection of any residual transmission.

The year ends with real – and fragile – progress: the longest stretch in history without wild poliovirus in Africa, large outbreaks stopped in the Middle East and the Horn of Africa, a certified polio-free South East Asia and no wild poliovirus type 3 for over 2 years. This will be the last weekly update of 2014.

In the north of Madagascar, supplementary immunization activities are planned for December in response to the outbreak of circulating vaccine derived poliovirus. National Immunization Days are planned for January. The aim is to boost immunity across the country against all strains of poliovirus using trivalent oral polio vaccine.

For the first time ever, only 1 case of wild poliovirus has been reported in Africa in the last 4 months. The case had onset of paralysis on 11 August in Somalia.

In response to the outbreak of circulating vaccine-derived poliovirus (cVDPV) in South Sudan, over 19,000 children were vaccinated last week in Bentiu Poc, where the two cases were reported. Outbreak response plans are in place to hold three rounds of supplementary immunization activities (SIAs) in high risk areas to stop transmission of the virus.

On 13 November, the Director-General of WHO accepted the recommendation of an International Health Regulations (IHR) Emergency Committee of Experts on polio that the international spread of polio continues to constitute a Public Health Emergency of International Concern (PHEIC) under the IHR, and extended the existing Temporary Recommendations to prevent the international spread of polio for countries affected by the disease for another 3 months.

The third meeting of the Emergency Committee under the IHR (2005) regarding the international spread of wild poliovirus in 2014 was convened by the Director-General through electronic correspondence from 2 through 7 November 2014.1 The following IHR States Parties submitted an update on the implementation of the Temporary Recommendations since the Committee last met on 31 July 2014: Cameroon, Equatorial Guinea, Pakistan and the Syrian Arab Republic.

In Madagascar, a circulating vaccine-derived poliovirus type 1 (cVDPV1) has been confirmed. The virus was isolated from one case of acute flaccid paralysis (AFP) with onset of paralysis on 29 September, and from three healthy contacts. An estimated more than 25% of children remain under-immunized against polio in the country. Madagascar was previously affected by a cVDPV2 outbreak in 2001/2002 (resulting in five cases) and in 2005 (resulting in three cases). Emergency outbreak response is being finalized, with campaigns to be held in December and January.

Two new cases of circulating vaccine derived polio virus (cVDPV) have been reported in South Sudan, constituting an outbreak. Immunization activities are planned in November and December in order to stop the spread of cVDPV.

Immunization campaigns in Iraq in September reached 88% of children under 5. Around 20 million children were vaccinated across the Middle East in October. These activities are helping to protect the gains made against the virus in the region, with no case reported for nearly 7 months.

The Global Polio Eradication Initiative’s 2013-18 Strategic Plan set a clear first objective: to stop wild polio virus transmission globally by the end of 2014. To deliver this formidable goal, the polio-infected countries and their partners made huge financial and operational pledges to complete the job they had started 25 years previously.

With just weeks to go until the end of 2014, this global target will not be achieved. The virus continues to thrive in two parts of the world that it has never been dislodged from.

Despite a return of seasonally normal rainfall during August, moisture deficits persist in northwestern Senegal. The delayed onset of the season in July has resulted in poor growing conditions and crop development.

Poor July rains in several local areas of Mali have resulted in poor crop and pastoral conditions. August and September rains have improved ground conditions, although the rainy season is quickly coming to a close.

More than 6 months has passed since a case of wild poliovirus was reported in Syria or Iraq. This is testimony to the dedication of local health workers and the significant efforts of many partners to reach all children with supplementary immunization activities. Over 22 million children have been vaccinated against polio multiple times in the past year, in the midst of active conflict and a humanitarian crisis.

All cases of wild poliovirus type 1 reported this week were from Pakistan. In 2014, Pakistan has accounted for 83% of cases reported globally. Khyber Pakhtunkhwa province and the Federally Administered Tribal Areas (FATA) constitute the most heavily infected area of the world, with 73% of cases worldwide occurring within these provinces.

The risk of international spread of polio from Pakistan remains high. The bulk of cases in neighbouring Afghanistan are linked to cross-border transmission with Pakistan, and the outbreak affecting the Middle East originated in Pakistan.

Iraq:Up to 13% of IDPs are located in areas that are currently not considered accessible by humanitarian actors. The overall number and geographical spread of IDPs pose a major challenge for provision of assistance. Approximately 1.5 million individuals are in need of emergency food assistance. An estimated 580,000 people are in urgent need of emergency shelter assistance.

A synchronised regional mass polio vaccination campaign in central and western Africa is currently underway to vaccinate nearly 94 million children in 18 countries with oral polio vaccine (OPV).

On 18 September, Nepal became the first GAVI eligible country to introduce inactivated polio vaccine (IPV) into its routine immunization programme. Plans are underway to introduce IPV into the immunization programmes of the 126 countries currently using only oral polio vaccine, ahead of a planned switch from trivalent OPV to bivalent OPV.

Ebola in Liberia, Sierra Leone, and Guinea: Transmission remains high, and case numbers doubled between the last week of August and the first of September in Liberia; in Sierra Leone 150 cases were reported for each of the last two weeks. Fewer cases have been reported in Guinea – 49 between 5 and 7 September – but the case fatality rate has been extremely high, at 65%.